- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.66 / $51.29 / $61.66
| Facility | | $42.66 | $51.29 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $43.65 / $50.12
| Professional | | $38.90 | $43.65 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $61.66
| Professional | | $39.81 | $39.81 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $104.71 / $112.20
| Professional | | $89.13 | $104.71 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $61.66 / $77.62
| Professional | | $51.29 | $61.66 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $72.44 / $77.62
| Professional | | $21.38 | $72.44 | $77.62 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $60.26 / $109.65
| Professional | | $43.65 | $60.26 | $109.65 |